Ryan, who has at times had a tense relationship with Trump, the Republican presidential nominee, also said repeal of ObamaCare is a reason why Trump should be president.

“Imagine if we had a Republican president,” Ryan told radio host Hugh Hewitt. “This is what Donald Trump is talking about — a special session. We’ve already proven this year with a Republican House and a Republican Senate we can have that special session, and we can repeal, and we can replace ObamaCare.”

This may seem like same-old, same-old at this point. After all, lots of health insurers are threatening to leave the exchanges. You could be forgiven for yawning at the news that yet another company might pull back.

But in fact, this is huge news, because Anthem runs the Blue Cross/Blue Shield organizations in 14 states. And though Anthem doesn’t appear to be the sole company offering exchange coverage in any of those states, the Blues are generally the backbone of the exchanges. Where others have quailed, the Blues have by and large stuck with Obamacare. If they pull out, then it’s likely that we’ll see more counties, and possibly entire states, with no Obamacare policies on offer.

While Obamacare has brought health insurance to millions of people in the U.S., some in the program are finding that the medical care they need is too expensive to actually use.

Michelle Harris, a 61-year-old retired waitress in northwest Montana, has arthritis in both shoulders. She gets a tax subsidy to help buy coverage under Obamacare, though she still pays $338 a month for the BlueCross BlueShield plan. Yet with its $4,500 deductible, she says she’s doing everything she can to avoid seeing a doctor. Instead, she uses ibuprofen and cold-packs.

“It hurts, but we don’t have that kind of money,” Harris said in an interview. “So I deal with it.”